Hard liver

Introduction Liver cirrhosis is a common chronic liver disease that can cause liver damage from one or more causes. The liver is progressive, diffuse, and fibrous. The specific manifestations are diffuse degeneration and necrosis of hepatocytes, followed by fibrous tissue hyperplasia and hepatocyte nodular regeneration. These three changes are repeatedly staggered. As a result, the hepatic lobular structure and blood circulation pathway are gradually reconstructed, causing the liver to deform and harden. Causes cirrhosis of the liver. There was no obvious symptoms in the early stage of the disease, and a series of different degrees of portal hypertension and liver dysfunction occurred in the later stage until complications such as upper gastrointestinal bleeding and hepatic encephalopathy occurred.

Cause

Causes:

There are many causes of cirrhosis, and the following factors can cause cirrhosis:

Viral hepatitis

Viral hepatitis (especially type B and C) is the leading cause of cirrhosis in China, and most of them develop portal cirrhosis. Hepatocytes in patients with cirrhosis are often positive for HBsAg, and the positive rate is as high as 76.7%.

2. Chronic alcoholism

Cirrhosis caused by alcoholic liver disease in Europe and the United States can account for 60% to 70% of the total.

3. Nutritional deficiency

Animal experiments have shown that animals fed a diet lacking choline or methionine can develop cirrhosis through fatty liver.

4. Toxic poisoning

Long-term effects of certain chemical poisons such as arsenic, carbon tetrachloride, and yellow phosphorus on liver may cause cirrhosis.

5. Drug-induced hepatitis cirrhosis, long-term use of some drugs that damage the liver can cause cirrhosis

Pathogenesis:

The main pathogenesis of cirrhosis is progressive fibrosis. The collagen (I and III) of the normal liver tissue is mainly distributed around the portal area and the central vein. Collagen type I and type III increased significantly in cirrhosis and settled throughout the lobules. With the continuous deposition of collagen in the sinusoids, the endothelial cell window pores are significantly reduced, and the hepatic sinus gradually evolves into capillaries, resulting in a disorder of material exchange between blood and liver cells. A large amount of collagen in cirrhosis comes from fat-storing cells (Ito cells) located in the sinusoidal cavity (Disse cavity), which is actively proliferating and can be transformed into fibroblast-like cells. The fibrotic tissue of the early hyperplasia is called liver fibrosis when it forms a small strip but does not connect to each other to form a space and remodel the hepatic lobular structure. If the development continues, the interfiber spaces in the central area of the lobules and the portal area will be interconnected, and the hepatic lobular structure and blood circulation will be reconstructed to form cirrhosis.

an examination

Related inspection

Hepatic prothrombin activity test tumor contrast imaging A-Man's test aminopyrine breath test liver, gallbladder, spleen CT examination

Diagnostic points

1, insidious onset, fatigue, loss of appetite, abdominal distension, diarrhea, weight loss and so on.

2, hepatomegaly, hard edges, often nodular, spider mites, liver palm, splenomegaly, abdominal varicose veins, ascites and so on.

3, often with mild anemia, decreased platelets and white blood cells. Combined with increased bilirubin, ALT, AST, GGT, prolonged prothrombin time, decreased plasma albumin, inverted A/G ratio, and increased alpha-fetoprotein.

4, B ultrasound can prompt diagnosis. Esophageal barium meal seeing X-ray positive signs of varicose veins also has a decisive diagnostic significance.

Auxiliary inspection

For patients with stable chronic liver disease, a full liver examination should be performed at least every 3-6 months. Such as hepatitis B patients, including liver function, hepatitis B pathogens, alpha-fetoprotein quantification and liver B-ultrasound, suspicious patients also need to carry out enhanced CT scan of the liver. If you find abnormal performance, you need to go to the formal medical department for treatment. If you listen to false medical advertisements, it is easy to go astray. Hepatic metastasis is a late manifestation of liver disease and is closely related to liver cancer, so patients should regularly check the following items:

(1) assay: alanine aminotransferase, aspartate aminotransferase, Y-glutamyl transpeptidase, alkaline phosphatase, prothrombin time and activity, bilirubin, alpha-fetoprotein, white blood cell classification, platelet count, urea nitrogen . Liver function is generally considered to be the level of inflammation in the liver that reflects the level of serum transaminase in liver function tests. If the patient's serum aminotransferase is high, even with jaundice, this often indicates that liver inflammation is more obvious and requires further treatment.

Etiology

Includes two pairs of hepatitis B antigen antibodies and HBV-DNA. HbsAg-positive is a marker of hepatitis B carriers, such as HbsAg-negative and HbsAb-positive, which has the ability to resist hepatitis B infection. HBeAg and HBV-DNA positive are indicators of active viral replication. At this time, the patient is highly contagious and should be given sufficient attention to regular antiviral therapy, such as nucleoside analogues such as lamivudine.

(2) Image examination: B-ultrasound exploration of liver, gallbladder and spleen, cardiopulmonary fluoroscopy, esophageal sputum meal. Liver B ultrasound is a reference for assessing the degree of cirrhosis, combined with the increase in alpha-fetoprotein, is also a tool for early detection of liver malignancy.

(3) Others: CT scan of gallbladder, liver and spleen, isotope liver scan, etc. If the B-ultrasound is found to be a problem, a liver-enhanced CT scan can be added, which can greatly improve the effectiveness of early liver cancer diagnosis. Hepatitis B and cirrhosis are the basis for the development of liver cancer. Patients pay attention to routine physical examination, usually early detection, early diagnosis and early treatment, and strive for a favorable opportunity to obtain a good prognosis. Blood routine can detect the levels of white blood cells, hemoglobin, and platelets, and assess the severity of hypersplenism. Alpha-fetoprotein can be used to screen early liver cancer.

For patients with stable disease and clinical asymptomatic, check once in 1 year and a half, and have symptoms such as discomfort and fatigue in the liver area, and check once every six months to one year. Suspected cirrhosis and cancer change 1 month check.

The specific inspection items, review time, should be decided by the clinician according to the specific circumstances, in order to fully understand the condition and guide treatment. Patients with cirrhosis, such as generalized fatigue, anorexia greasy, yellow urine, yellow eyes, yellow urine, decreased urine output, accelerated abdominal distension, right upper quadrant pain, and even personality changes in nonsense, do not favor doctors Langzhong, please go to the regular hospital for medical treatment.

Cirrhosis is a common chronic liver disease caused by long-term or repeated action of one or more causes, causing diffuse damage to the liver. In the early clinical stage, due to the strong liver function compensation, there may be no obvious symptoms. In the later stage, there are multiple system involvement, with liver function damage and portal hypertension as the main manifestations, and often gastrointestinal bleeding, hepatic encephalopathy, secondary infection, Serious complications such as cancer.

Differential diagnosis

Identification:

(1) Hepatomegaly should be differentiated from chronic hepatitis, primary liver cancer, liver echinococcosis, clonorchiasis, chronic leukemia, and hepatolenticular degeneration.

(2) Ascites should be differentiated from cardiac insufficiency, kidney disease, tuberculous peritonitis, constrictive pericarditis.

(3) Splenomegaly should be differentiated from malaria, chronic leukemia, and schistosomiasis.

(4) Acute upper gastrointestinal bleeding should be differentiated from peptic ulcer, erosive hemorrhagic gastritis, and gastric cancer.

Diagnostic points:

1, insidious onset, fatigue, loss of appetite, abdominal distension, diarrhea, weight loss and so on.

2, hepatomegaly, hard edges, often nodular, spider mites, liver palm, splenomegaly, abdominal varicose veins, ascites and so on.

3, often with mild anemia, decreased platelets and white blood cells. Combined with increased bilirubin, ALT, AST, GGT, prolonged prothrombin time, decreased plasma albumin, inverted A/G ratio, and increased alpha-fetoprotein.

4, B ultrasound can prompt diagnosis. Esophageal barium meal seeing X-ray positive signs of varicose veins also has a decisive diagnostic significance.

Auxiliary inspection:

For patients with stable chronic liver disease, a full liver examination should be performed at least every 3-6 months. Such as hepatitis B patients, including liver function, hepatitis B pathogens, alpha-fetoprotein quantification and liver B-ultrasound, suspicious patients also need to carry out enhanced CT scan of the liver. If you find abnormal performance, you need to go to the formal medical department for treatment. If you listen to false medical advertisements, it is easy to go astray. Hepatic metastasis is a late manifestation of liver disease and is closely related to liver cancer, so patients should regularly check the following items:

(1) assay: alanine aminotransferase, aspartate aminotransferase, Y-glutamyl transpeptidase, alkaline phosphatase, prothrombin time and activity, bilirubin, alpha-fetoprotein, white blood cell classification, platelet count, urea nitrogen . Liver function is generally considered to be the level of inflammation in the liver that reflects the level of serum transaminase in liver function tests. If the patient's serum aminotransferase is high, even with jaundice, this often indicates that liver inflammation is more obvious and requires further treatment.

Etiology:

Includes two pairs of hepatitis B antigen antibodies and HBV-DNA. HbsAg-positive is a marker of hepatitis B carriers, such as HbsAg-negative and HbsAb-positive, which has the ability to resist hepatitis B infection. HBeAg and HBV-DNA positive are indicators of active viral replication. At this time, the patient is highly contagious and should be given sufficient attention to regular antiviral therapy, such as nucleoside analogues such as lamivudine.

(2) Image examination: B-ultrasound exploration of liver, gallbladder and spleen, cardiopulmonary fluoroscopy, esophageal sputum meal. Liver B ultrasound is a reference for assessing the degree of cirrhosis, combined with the increase in alpha-fetoprotein, is also a tool for early detection of liver malignancy.

(3) Others: CT scan of gallbladder, liver and spleen, isotope liver scan, etc. If the B-ultrasound is found to be a problem, a liver-enhanced CT scan can be added, which can greatly improve the effectiveness of early liver cancer diagnosis. Hepatitis B and cirrhosis are the basis for the development of liver cancer. Patients pay attention to routine physical examination, usually early detection, early diagnosis and early treatment, and strive for a favorable opportunity to obtain a good prognosis. Blood routine can detect the levels of white blood cells, hemoglobin, and platelets, and assess the severity of hypersplenism. Alpha-fetoprotein can be used to screen early liver cancer.

For patients with stable disease and clinical asymptomatic, check once in 1 year and a half, and have symptoms such as discomfort and fatigue in the liver area, and check once every six months to one year. Suspected cirrhosis and cancer change 1 month check.

The specific inspection items, review time, should be decided by the clinician according to the specific circumstances, in order to fully understand the condition and guide treatment. Patients with cirrhosis, such as generalized fatigue, anorexia greasy, yellow urine, yellow eyes, yellow urine, decreased urine output, accelerated abdominal distension, right upper quadrant pain, and even personality changes in nonsense, do not favor doctors Langzhong, please go to the regular hospital for medical treatment.

Cirrhosis is a common chronic liver disease caused by long-term or repeated action of one or more causes, causing diffuse damage to the liver. In the early clinical stage, due to the strong liver function compensation, there may be no obvious symptoms; in the later stage, there are multiple system involvement, with liver function damage and portal hypertension as the main manifestations, and often gastrointestinal bleeding, hepatic encephalopathy, secondary infection, Serious complications such as cancer.

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